HEALTHCARE DESIGN

2010 ARCHITECTURAL REVIEW

SUBMISSION FORM

Thank you for participating in the HEALTHCARE DESIGN 2010 Architectural Review. This is the only form due at this time. Instructions for preparing your presentation will be e-mailed to the Submission Coordinator on or before March 26.

Please complete and submit one form per project. You may submit as many projects as you wish. Keep in mind that the Submission Fee is non-refundable, and if your project(s) is accepted you will be invoiced for the appropriate publication fees. We do not allow cancellations following acceptance.

Please feel free to contact Donna Paglia at 216.373.1210 if you have any questions.

We look forward to seeing your project!
Name of Project: *
 
Project Location (City/State/Country): *
All published submissions featuring facilities located outside of the United States will be published in the OCTOBER 2010 International Showcase unless otherwise requested by participating firm at the time of submission. All projects featuring facilities within the United States will be featured in the SEPTEMBER 2010 Architectural Showcase.

Firm Contact Information:
Company: *
Address: *
City: *
State: *
ZIP: *
Country: *

Who will be coordinating this project submission?
Submission Coordinator *
E-mail: *
Phone: *
Fax: *

Please select the setting that best describes your project (check all that apply):
*Note: To de-select a category, click on the checkbox again.
 *
Aquatic Therapy Center
Common/Administrative Area
Dental/Vision Care Office
Diagnostic and Imaging Center
Education Center
Emergency Services
Entryway/Lobby
Fitness Center
Freestanding Surgery Center
Hospital Chapel
Medical Office Building
Medical Specialty Dept/Unit: (Cancer, pediatric, critical care, ambulatory care, birthing center)
Outdoor Space (courtyard, common area)
Outpatient Center
Physicians' Office
Rehabilitation Center
Research Institution
Specialty Hospital/Medical Center
Wellness Center
Other: (please describe below)
If other, please describe:

Please select the Building/Construction category that best represents this project:
 *
All projects must have been completed between January 2007 and December 2010, except Projects in Progress or Unbuilt/Conceptual Designs. Previously published projects may not be resubmitted under the same project category. For example, a Project in Progress can be resubmitted once complete under the New Construction category; however, it cannot be resubmitted again under Project in Progress.
 
If this project is accepted for publication, please indicate the number of pages you wish to reserve for your project layout. This is for planning purposes only and is not released to the review panel.
 *
1 Page - Submission Fee $400; Publication Fee $2,950)
2 Pages - Submission Fee $250; Publication Fee $4,750)
3 Pages - Submission Fee $100; Publication Fee $6,100)
 
How do you wish to pay your Submission Fee?
 *
Check (please see instructions below)
MC
VISA
AMEX
 
Please make checks payable to Vendome Group and mail to:

Donna Paglia, Marketing Manager
HEALTHCARE DESIGN
3800 Lakeside Ave., East, Suite 201
Cleveland, OH 44114

*Note: If submitting more than one project, one check covering submission fees for all projects is acceptable.

For credit card payments: Your confirmation will include a section for entering your credit card information. Please complete and return to complete the submission process.
 
Submission Authorization:
If this project is accepted for publication by the review panel, I understand that our firm or facilty will be invoiced the appropriate publication fee based on the number of pages indicated above and that I may not cancel publication of my project once it is received and accepted.
Your Name: *
Date: *

To complete your submission, click SUBMIT FORM below. The Submission Coordinator will receive a confirmation shortly. Thank you!